Veterans Affairs Committee on March 20th, 2007

[Col Donald S. Ethell]

That quote, by the way, is from Stéphane Grenier. It's a very famous quote, as a matter of fact.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Yes, it's quite good actually. I'm going to use it.

[Col Donald S. Ethell]

This is an ongoing problem in regard to reservists. They disappear. Sometimes they don't want to have anything to do with the military. For that matter, in some cases, some guys in the regular force want to just switch off and go away. It's difficult. I know I'm getting into Major Le Beau's business here, but it's been a fact of life for years, and they just disappear.

Having said that, if they come forward to any of the PSCs or the FPMCs, they're there. In fact, they'll talk to anybody if they've got a problem in regard to the military.

[The Chair, Conservative, Rob Anders]

Mariane.

[Maj Mariane Le Beau]

Yes indeed, there is no difference for us, whether you're regular reservists or class A, class B, class C. That doesn't make any difference in respect to our services at OSISS.

I would say that the issue of reservists is something that the reserve units themselves are more and more aware of. And we have been asked—more so in the past year, actually, than we had been previously—to provide outreach briefings and information sessions to reserve units. So, again, it's a process, and it's getting there. That's the first one.

Regarding the type of program that OSISS is, there are variations. But I could sit down and really explain to you the details of how peers function, how we consider that they are not counsellors. There have been peer programs in the U.S. in the past. We would provide them with counsellor training and they would be counsellors. We have stayed away from that. Our peers are not counsellors; they are peers, and they don't do counselling. They're buddies in some ways, if you want to put it in that kind of context.

So in that respect, for NATO, as far as I know, it's like saying there are no two snowflakes exactly alike. You have to see all of the snowflakes. As far as I know, there is no program, and in the literature there is no program that is exactly like OSISS, and we do share with our colleagues.

Kathy, do you want to pick up on that one?

[Kathy Darte]

In response to your question on reservists, I just want to point out that, as I said earlier, everybody is welcomed into the OSISS program. We serve those in uniform and those out of uniform.

We have a number of reservists who have come forward and accessed services under the OSISS program. One of our trained peer support workers in the program is himself a reservist. His name is Vince Tytler, and he's working from Vancouver.

A large part of the coordinators' role is to make themselves known in their respective geographic areas, and part of that is networking. Part of that is going out and speaking to reserve units, telling them about the OSISS program and the services that are available, and just spreading the word in general.

Part of our program is not only providing one-on-one assistance to individuals, but also bringing veterans and members together in a group setting. Part of these group meetings involves reservists. They come and they meet with other peers, other buddies, other reserve members, other regular force members, and other veterans. So it's by word of mouth.

It is a challenge, because you're quite right, they do go back to their home locales. So we just have to continuously work on raising the awareness and education and on making the program known.

Regarding the international and best practices, that's a really good question. We—the managers, Lieutenant-Colonel Grenier, Major Le Beau, and I—have presented on our program internationally on a number of occasions. We know we have a really unique program.

There isn't a program anywhere in the world that's similar to this program in terms of how we've set it up. Other countries are looking to us. They want to hear about the program, so we've presented in Australia, in the U.S., in Europe. We are invited again to go back to Europe this year. We have presented to NATO.

There are a number of programs around the world that the militaries and veterans affairs have set up, but they're slightly different from ours. I think part of our success—and these other countries are identifying that—comes from both Veterans Affairs and National Defence's working together on this program. There's not a separate veterans program from the VA department and a separate Defence program. There's a program for all, in uniform or out of uniform, and families.

The other things we hear about from our international colleagues are the parameters and the emphasis that we put on this program. These individuals are very well trained. We do not just hire them and put them out to work. They all come with the same criteria for selection, namely that they must be a veteran—they must have been in the forces—and they must have an injury.

Then we train them. We provide extensive training, which is done by Ste. Anne's Hospital. Our Veterans Affairs mental health staff at Ste. Anne's Hospital, along with other individuals from Defence and from Veterans Affairs, provides training. It's almost continuous training. It's ongoing. We continuously reinforce.

The other things we emphasize in our program are boundaries—you have to stick within your role—and self-care, because in order to work with others you have to take care of yourself.

So I think the other countries are noticing that this is a very formalized program. It's formalized in how we've set it up and in how we continue to monitor these people. We continually need to watch them. Dr. Richardson—who's the medical advisor for Veterans Affairs to the program and who unfortunately couldn't be with us today because he's on holidays—and I are following these people through long-term research, looking at their health and well-being. We measure their health when they start to conduct this work for us, and then we continuously measure their health over the course of their employment with us.

Basically, what we're finding is that there is no decrease in the level of health of these individuals. In fact, they are getting better, and it's because they are now able to get back into the workforce, contribute to society, and help others who are in the same situation they were in.

[Col Donald S. Ethell]

Mr. Chairman, I'd just like to go back to a point that Mr. Stoffer made, and it's very important, in regard to people in the reserves falling away. Correct me if I'm wrong, Mariane, but all of the peer support counsellors are ex-NCMs, not officers. There's a good reason for that, recognizing that officers command and NCOs control men and they're on the ground. Secondly, Sergeant Bloggins is going to find it easier to talk to Sergeant Major or Corporal Smith rather than Colonel Whoever, regardless of how good they are, regardless of whether they've got the uniform on or not.

The other point was about people falling through the cracks, be it reservists or others. I'm not a psychiatrist, but I do know, and others in our area know full well, that stressful situations can be cumulative—the Sabra and Shatila massacres, Bosnia, going into Afghanistan, and so forth. The lads, or the troops who are serving over there now, may not know it right now, but two or three years downstream, as happened with Grenier to a certain extent, it will accelerate and intensify. His problem intensified. Having said that, those people now know that if there's a problem that does come up, they can come back; they don't have to go and hide in a hole or go out in the woods and so forth. They can come back and go down to the district office of VAC or they can track down a peer, a PSC, and ask: What can I do? Can you help me? Where can I go? Where can you refer me to? That's one of the strengths of that.

[The Chair, Conservative, Rob Anders]

Mr. Stoffer, we're in an incredible situation. Due to the length of the witnesses' responses, you've had three times your normal amount of time. Wow.

Now on to Mrs. Hinton for seven minutes.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Good morning.

I've had the opportunity on several occasions to be in the company of Colonel Ethell. There are a couple of comments I'd like to make, and I have one question that I'd like all four of you to answer afterward.

The comment I'd like to make is how much I enjoy your candour; you usually say exactly what's on your mind, which is exactly what we want to have happen in this room. You did make a comment earlier today, though, regarding the peer program, and you spoke about psychologists and psychiatrists, which I recognize you have a great deal of respect for, but I think the comment you made hit home with me. I think what I heard you say is that there's no substitute for experience, which is why you value the peer program as much as you do. I happen to agree with you. I think if you've been in the situation, you're in a far better position to support somebody who's going through these kinds of traumas, and I'm very pleased to hear more detail about the peer program. It's very interesting for me.

Another comment I wanted to make is I have a great deal of respect for everyone on this committee, but Mr. Perron and I may disagree on one point he made. I think there would be more stress if the plane, the truck, the tank, or the tools that are necessary to do the job weren't there. I think that would add to the stress that our men and women in uniform face on a daily basis.

In terms of reservists, I have one of the finest reserve groups in the country in my riding; they're called the Rocky Mountain Rangers. I know they do have a group of people who can talk to one another and they do have a spot where they can get together. So I'm hoping there's that kind of support group. Major Le Beau reinforced that today, that these kinds of programs are accessible and they can get help. So that's a positive thing.

I'm going to ask all four of you to answer a question that I have asked of every witness that has appeared in front of this committee on this issue. To date, no one has been able to answer it. How do you think Veterans Affairs Canada can contribute to changing the negative stereotype for veterans who suffer in silence from PTSD?

[Col Donald S. Ethell]

Thank you. That's an excellent question.

First of all, thank you for your kind remarks. I appreciate them.

I'll get around to your question in a minute, but just to go back to your point on experience in regard to clinical staff, psychologists and so forth, as you may be aware, the first ones went out to the field for two to three weeks initially in Bosnia, which wasn't long enough. Having been there, the troops viewed them with a bit of a jaundiced eye—that “I'm from NDHQ and I'm here to help you” kind of thing. The troops would much rather talk to their peers.

Having said that, it's my understanding—and this is a personal opinion—that the Canadian Forces health system is intentionally pushing clinical staff out into the field in Afghanistan, as you've heard. There's one there. The chief psychiatrist just came back from a four-month tour, and there are two psychiatrists who have replaced him. There is an individual in Halifax who was at one time a unit medical officer in Rwanda and a unit medical officer on the Golan Heights, who has specialist training and has spent one, if not two, tours in Afghanistan as the psychiatrist. He is the kind of guy who will take off his rank and talk to the soldiers; he is very, very good at it. So experience is building among the clinical staff, in addition to the experienced field soldiers who are talking to each other. But thank you for making that a point.

The change for the VAC or Veterans Affairs—and I'm saying this more as an individual rather than as a departmental employee of either department, which I'm not—has been dramatic, you could almost say, from ten years ago in regard to a caring attitude. Ten years ago there was almost an adversarial approach when somebody came forward to VAC for some type of annuity, treatment, and so forth. It's changed dramatically because the benefit of the doubt now goes to the individual—and obviously there's a certain bureaucracy individuals have to go through.

The culture is different, in my opinion, and that started with some significant changes within VAC six to eight years ago, when the emphasis was put on the individual rather than the system, with the benefit of the doubt now going to the individual. So I'm very positive that this type of activity will continue. With the example of the two circles overlapping, as Mr. Stoffer has indicated, or the seamless approach I mentioned, people are less likely to drop through the cracks than they were a number of years ago. Are there going to be people who will drop through the cracks? Of course. No system is perfect. But at least we've made significant inroads.

I don't know if that answers the question or not, Ms. Hinton, but thank you for asking it.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

It's close. I'll just repeat the question so there's no misunderstanding at all.

What can Veterans Affairs Canada do to change the negative stereotype—because it's out there—for people who suffer from this silent disease? What can we do?

[Col Donald S. Ethell]

What can they do?

You have a folder with a whole bunch of handouts. These are all over the place, at all the bases and all the offices. There are TV ads, and so forth. It's a monumental communications problem. The district directors have all of the veterans associations in once a quarter—and if not, the regional directors will have them in once every five months—to spread the gospel. They go out to service clubs and to regimental associations, and so forth, to talk about Veterans Affairs. I'm saying this as someone from western Canada who has participated in all of them. I've gone to listen and have heard the same thing a couple of times. We talk about this and we're quite frank. For example, on Friday in Calgary there will be a presentation by one of the peer support coordinators, along with those from Veterans Affairs Canada.

The district director is really saying to the representatives of all the veterans associations: this is where we're coming from, and please get out there and tell the people how we can help. That didn't happen many years ago.

So the emphasis is coming from Charlottetown through the regional directors, down to the district directors, if not directly, to get out there and spread the gospel.

Mariane.

[Maj Mariane Le Beau]

I'm sure you could see me smile.

Kathy and I actually read an article last night that was sent to me electronically from the U.S. I imagine it was published recently. It talks about stigma, a model of stigma that talks about self-stigma, how we perceive the stigma that's out there, and what seems to be the best way to work against stigma.

In many ways, this is what Don said. OSISS is probably the best program to help work against the stigma, because people who have gone through the experience have become better and are out there. There can be interaction, information, and education. It will probably be the best way to fight stigma.

If you want, ma'am, I can provide you with a copy of the article, if you're interested.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you.

[The Chair, Conservative, Rob Anders]

It's a good point.

Kathy.

[Kathy Darte]

I would like to follow up on that. I can actually say the support of Veterans Affairs for the OSISS program is really helping to change the stigma that's out there, both in society as a whole and within individuals.

There are 17 peer support coordinators working in the program, and 15 of those individuals are working from back offices. Within the back offices now there are individuals who are veterans and are actually clients of our department. They have gone through treatment, have recovered, and are out there helping other veterans. They are greatly assisting in our offices to help with the understanding and awareness of what it's like for individuals to live with these kinds of injuries. There is a lot of consultation between the Veterans Affairs staff and the peer support coordinators when they discuss what it's like to live with the impacts on the individuals and on their families. I think it's a big advantage.

At our OSI clinics, our operational stress injury clinics, we also have two family members, two family peer support coordinators who work from the clinics. It's another way of bringing in those who have lived the experience and who are prime examples showing that if they get into treatment early, they can recover and get back into society to fully contribute, to work, and to have fully functional families again. I think it's a big step in helping to raise awareness.

I think the article Mariane has referred to is an excellent article. It talks about stigma, the two kinds of stigma. It talks about societal stigma, which we all know is out there, as it relates to operational stress injuries. It also talks about self-stigma, the self-stigma within the individuals themselves.

In OSISS we're promoting early treatment, identification of the problem, and treatment. The self-stigma is part of what prevents people from getting into treatment, because they feel if they self-identify, it's going to have an impact on them in one way or another. We can encourage folks to come forward early, because if they get into treatment early, the recovery time is much shorter, with fewer impacts on them as individuals and on their families.

[The Chair, Conservative, Rob Anders]

Thank you.

Jim.

[LCol Jim Jamieson]

I'll be brief. I'd like to suggest three things.

Number one, I think VAC has to go out of its way to recognize veterans with mental health concerns related to operations, to service, to recognize them as heroes.

Secondly, and somewhat related to this I think—and I can say this because I'm not a VAC employee—in regard to staff training, this is the new veteran we're dealing with. It's no longer the Korean and World War II veterans, by and large, who tend to be pleasant in the office. People with mental health concerns are not always pleasant, but they are our customers. They are the people we serve. We need, right from the receptionist, who's incredibly important, to give recognition to these people, not to treat them as security threats who we talk to from behind laminated glass plates. I realize there's a balance between security and recognition, and I've been to many VAC offices and the staff by and large are great, but often you walk in and you feel like you're a threat to them, because there's this glass thing and no eye contact. “What do you want?” is the message you get. When you're already prickly, I think that recognition, that the reason I'm here is that you are the person I serve, has to be the first message, not that you could be a threat to us. I realize this is a very delicate issue.

I think the third thing, which my colleagues have been saying, is to continue to support OSISS. I'm not a direct employee of OSISS. I have a job whether OSISS exists or not. But it is a great thing, and I hope VAC will continue to support it.

Those are my suggestions. I think it's a multi-faceted problem. There's no simple solution to the stigma problem.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you so much.

[Col Donald S. Ethell]

With all due respect to Jim Jamieson's slight criticism of VAC—and I don't work for VAC either—that can be countered in part by the strengths of the OSISS program, because there are people who won't go near a VAC office, they won't go into the clinic on the base, but they will track down a peer because of word of mouth. If they need to go and talk to someone, it's the PSC.

Ms. Darte has indicated that the PSCs have their office within the district director's office. They don't necessarily meet their clients there, or peers. Some of them will, but others ask, “Do you want to meet here? If not, we'll go somewhere else. Do you want me to come to your home, or do you want to meet wherever?” And they'll get together outside the home. In other words, there's that conscious effort to make sure that people don't run into that wall, as Jim has rightfully said, coming through the door and there's a hesitation.

If you have an injury to your arm, it's going to get fixed. If you're going to walk into the doctor's office, first of all you have to admit that you have a problem. If you have a problem, then are you going to admit it to somebody else? That's the problem that Jim is indicating, because when you go into that office, you are defensive. “Am I going to talk to the doctor, or do I have to go and see a psychiatrist? I'm going to maybe talk to the padre or the minister, and so forth. Who am I going to talk to? My wife won't talk to me because I know she knows I've changed.” So there's that barrier to get around, going into the Veterans Affairs office.

Thank you very much. Did we answer the question, Ms. Hinton?

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Yes. That's the best answer I've gotten in all the witnesses we've been listening to. We listened to a group of witnesses before, relating to this issue.

I especially appreciate what Major Le Beau said, which will be very helpful, and also what Lieutenant-Colonel Jamieson said. That's constructive criticism, as far as I'm concerned, and I will be happy to pass that information on.

[LCol Jim Jamieson]

It's meant to be constructive.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Yes. It's very constructive.

[Col Donald S. Ethell]

They were excellent questions, and I thank you for that.

As Ms. Darte has indicated, there are many countries looking at these people and asking, “How are you doing it?” At the end of this session, I have copies of a book to present to you and your committee, and one for the library here, Mr. Chairman, on combat stress injuries, written by a former U.S. marine and by a U.S. Navy captain, a psychologist and an Iraqi veteran. And there's a chapter in here written by four of our colleagues: Kathy Darte, Stéphane Grenier, Major Heber, and Dr. Richardson. That's all here. In fact, Naval Captain Nash, from Quantico, Virginia, has attended our meetings and has presented.

So they are looking at these people and saying, “Okay, how can we make this program work?” They have to have something good on the mark to be invited, as is indicated, to go to the Hague and to various other countries, and they're off and running early next month, back in the United States, to brief on the OSISS program—the very successful OSISS program.

Thank you for the question.

[The Chair, Conservative, Rob Anders]

Thank you very much.

Now over to Mr. Cuzner of the Liberals for five minutes.